The February 1 issue of the New England Journal of medicine has an article by Fitzhugh Mullen MD about the flight of Ghanaian professionals out of Ghana, to the United States and Europe. Doctors and nurses can make a lot more money in the US or UK.

“It’s the same for football players as it is for doctors,” I was told by Tsiri Agbenyega, dean of the medical school in Kumasi, Ghana. “We have to train a lot more than will end up in Ghana, because they all leave. The football players go to Europe, and the doctors to America and the U.K.” Agbenyega spoke with a mixture of frustration, pride, and resignation. He was pleased that Ghanaian athletes and physicians were competitive internationally, but their success meant a loss to the country — a loss more problematic in medicine than in football.. . .Ghana has a strong tradition of education, a public health system that has resulted in greater longevity and lower infant mortality than in much of West Africa . . . If Ghana could show the way, one might think, other African countries might be able to follow.But not so. For much of the past decade, health improvement in Ghana has been at a standstill . . . Today, there are 532 Ghanaian doctors practicing in the United States. Although they represent a tiny fraction of the 800,000 U.S. physicians, their number is equivalent to 20% of Ghana’s medical capacity, for there are only 2600 physicians in Ghana. An additional 259 Ghanaian physicians are in practice in the United Kingdom and Canada — and this group includes only those who have successfully been licensed after leaving Ghana.. . .“Our only recourse is to try to train more in the hopes we will keep more,” explained Yaw Boasiako of Ghana’s Ministry of Health, who outlined an ambitious plan for doubling the number of physicians and nurses educated in the next few years. Ghana, like many English-speaking developing countries, is caught in an educational conundrum: the better the quality of their universities and the more health professionals they train, the more they lose to the United States and the United Kingdom. They have a leaky bucket now. In desperation, they’re building a bigger leaky bucket.

But that’s not all they’re doing. As in most developing countries, the private medical sector is small, and most physicians work for the government health service, which staffs the public hospitals and clinics where most people receive care. Although the salaries of Ghanaian doctors are better than those in many African countries, doctors are quick to point out that their pay is still modest. “A trained physician can make more in London in two months than we can make in a year in Ghana,” I was told frequently.. . .To augment physicians’ services, the ministries of health and education are expanding training opportunities for community health nurses, technical officers, and “medical assistants” — midlevel practitioners who substitute for doctors in shortage areas. For many years, the Rural Health Training School in Kintampo has provided experienced nurses with a year of advanced training and 6 months of internship to enable them to function independently as medical assistants. The school is doubling its class size to 200 but is changing to a non-nurse model, since the loss of nurses to emigration has depleted the ranks of program candidates. In the future, medical assistants will be secondary-school graduates who will receive 3 years of didactic training followed by a year of internship. Although all health care workers are subject to the pull of emigration, the global market for midlevel practitioners is not standardized, and the government hopes that most medical assistants will remain in Ghana.

. . . the single most important contribution that the United States could make would be to train more doctors at home . . . For 25 years, the number of students admitted to U.S. allopathic medical schools has remained constant, while the number of physicians we import has climbed steadily. Without ever enunciating a strategy of dependence on the world, we have created a huge U.S. market for physicians educated elsewhere, inadvertently destabilizing the medical systems of countries that are battling poverty and epidemic disease.

A commitment in the United States to ramp up medical school opportunities to a level closer to national needs would do much to slow medical migration and bring stability to medical programs in poorer countries. Perhaps soccer players will always migrate to the elite leagues of the world, but if doctors and nurses stayed closer to home, lives would be saved.

I would add that although medical professionals may be able to make a lot more money in the US or UK, there is a good chance they can live a lot better and more enjoyably in Ghana. At the same time, the Ghana government has to pay good professional salaries, and pay them on time.

The US should educate more of its own doctors and nurses. Unfortunately the Republican education policies of the last several decades have severely damaged US educational resources and opportunities. I’m hoping the tide is finally turning on this, but nothing is going to happen very fast.